Sharply angled kelly (Jacobs) clamp

ABSTRACT

A Jacobs type curved clamping or dissector element for a disposable laparoscopic instrument is provided. The Jacobs&#39; type end effectors generally comprises first and second pivotally mounted elongate, opposed clamp members each of which has a straight base portion, an intermediate portion extending away from the axis of the base portion and a curved distal portion which angles 70 to 90 degrees relative to the intermediate portion and which extends back toward and slightly beyond the longitudinal projection of the base portion. The clamp members note when pivotally rotated to a closed-clamp position.

This is a continuation of application, Ser. No. 07/780,035, filed Oct.21, 1991, now U.S. Pat. No. 5,215,101, which in turn is acontinuation-in-part of application Ser. No. 07/521,766, filed May 10,1990, now U.S. Pat. No. 5,133,727, and a continuation-in-part ofapplication 07/680,392, filed Apr. 4, 1991, now U.S. Pat. No. 5,192,298.

This application also relates to U.S. Ser. No. 07/780,014 now U.S. Pat.No. 5,171,258, which is also incorporated by reference herein.

BACKGROUND OF THE INVENTION

The present invention broadly relates to laparoscopic surgicalinstruments. More particularly, the invention relates to disposablelaparoscopic clamps useful in a laparoscopy procedure which involvesspreading, separating and dividing tissue (i.e., dissection).

The laparoscopy procedure has recently become a widely practicedsurgical procedure. A laparoscopy procedure typically involves incisingthrough the navel and through the abdominal wall for viewing and/oroperating on the ovaries, uterus, gall bladder, bowels, appendix,although more recently, incisions and insertion of trocar tubes havebeen made in different areas of the abdomen and even in the chestcavity. Typically, trocars are utilized for creating the incisions.Trocar tubes are left in place in the abdominal wall so thatlaparoscopic surgical tools may be inserted through the tube. A cameraor magnifying lens is often inserted through the largest diameter trocartube (e.g. 10 mm diameter) which is generally located at the navelincision, while a cutter, dissector, or other surgical instrument isinserted through a similarly sized or smaller diameter trocar tube (e.g.5 mm diameter) for purposes of manipulating and/or cutting the internalorgan. Sometimes it is desirable to have several trocar tubes in placeat once in order to receive several surgical instruments. In thismanner, organ or tissue may be grasped with one surgical instrument, andsimultaneously may be cut or stitched with another surgical instrument;all under view of the surgeon via the camera in place in the naveltrocar tube.

Previous to the present invention, laparoscopic tools have utilizedcurved Kelly type clamps with dissectors having a curved distal portionwhich was necessarily of limited transverse length (i.e., the lengthperpendicular to the longitudinal axis of the trocar tube) to permit itspassage through a trocar tube. However, because of the limitedtransverse length of the dissector members, laparoscopic Kelly typeclamps have found limited applicability, as they cannot readily reachotherwise inaccessible areas for dissection and/or clamping.

SUMMARY OF THE INVENTION

It is therefore an object of the invention to provide a laparoscopicsurgical instrument which dissector elements which traverse a relativelylarge transverse distance.

Another object of the invention is to provide disposable laparoscopicsurgical instruments having high leverage dissector elements.

It is a further object of the invention to provide a disposablelaparoscopic surgical instrument with dissector elements which anglesharply relative to the longitudinal axis of the instrument.

In accord with the objects of the invention, a "Jacobs" type curvedclamping or dissector element for a disposable laparoscopic instrumentis provided. The Jacobs type end effector generally comprises first andsecond pivotally mounted elongate, opposed clamp members each of whichhas a straight base portion, an intermediate portion extending away fromthe axis of the base portion and a curved distal portion which angles 70to 90 degrees relative to the intermediate portion and which extendsback toward and slightly beyond the longitudinal projection of the baseportion. The clamp members pivot to achieve a mutually in-registerposition when pivotally rotated to a closed-clamp position.

A better understanding of the disposable laparoscopic Jacobs' clampsurgical instrument of the invention, and additional advantages andobjects of the invention will become apparent to those skilled in theart upon reference to the detailed description and accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side elevation view, partly in section, of a disposablelaparoscopic instrument prior to insertion into a trocar tube, and, inpartial phantom format, after insertion into a trocar tube;

FIG. 1a is a cross section through FIG. 1 at the indicated location ofFIG. 1;

FIG. 2 is a side elevation view of the Jacobs type end effector clampsof the invention;

FIG. 3 and 3a are respectively a top plan view and a bottom plan view ofthe Jacobs type clamp device of FIG. 2 with clamps hooking right andleft respectively; and

FIG. 4 is a top plan view of a single clamping member of the device ofFIG. 2 with clamp hooking left.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

With reference to FIG. 1 and 1a, a disposable laparoscopic surgicalinstrument is indicated at 10. The disposable laparoscopic surgicalinstrument 10 includes an aluminum tube 15 surrounded by a peripheralinsulating shrink wrap layer of plastic 20, a clevis means 30, Jacobstype end effector 40, actuating means 50, and a push rod 60. The clevismeans 30 is preferably a separately formed aluminum piece which fixedlyengages aluminum tube 15. The clevis 30 also engages the Jacobs' clampmanipulating members 20, 22 of the end effector 40. Members 20, 22 arepivotally engaged to clevis 30 at pivot pins 45, 47 as more particularlydescribed in previously incorporated Ser. No. 07/780,014. End effector40 is preferably formed of investment cast bronze. Alternately, endeffector 40 can be formed of investment cast stainless steel, or othermetal as desired. The push rod 60, which is preferably formed ofstainless steel, is engaged at its distal end 65 to the end effector 40,as hereinafter more fully described, and is connected at 70, at itsproximal end, to a manually operable actuating means 50. For purposesherein, the "distal end" of the instrument 10 or any part thereof, isthe end closest to the surgical site and distant from the surgeon, whilethe "proximal end" of the instrument 10 or any part thereof, is the endmost proximate the surgeon and distant the surgical site.

In use, the laparoscopy instrument 10 is inserted with the manipulatingmembers 20, 22 of the end effector 40, in the closed position, intotrocar tube 80, as indicated at the arrow 85 of FIG. 1. The distalportion of the instrument 10 passes through the trocar tube 80 into bodyincision 100. Upon the distal portion of the laparoscopy instrument 10exiting the trocar tube 80, the manipulating members 20, 22 can beopened and closed as indicated at 105 by reciprocal motion of push rod60 which results from operation of the manual actuating means 50. Theclevis effectively translates the reciprocal motion of the push rod 60into the end effector means action indicated at 105.

With reference to FIG. 2, a curved clamping end effectors of the Jacobstype (an improved Kelly clamp) in accordance with the present inventionis shown at 40 having first and second clamp members 20, 22 pivotallymounted to a clevis 30 at transverse pivot pins 45, 47 to enable andopening and closing clamp motion as indicated at 140 upon actuation ofpush rod 60. The clamp members 20, 22 are preferably provided withhorizontal gripping grooves 13 on their gripping sides (see FIG. 4),with the grooves angling in a manner to be transverse the longitudinalaxis of each portion of the clamp member as the clamp member curves. Theflattened extension 62 of push rod 60 is coupled to clamp members 20, 22by metal connectors 50, 52 which engage cutouts 172 in the end portions170 of the clamp members 20, 22. The metal connectors 50, 52 areattached to the flattened extension 62 by pin 181 (seen in FIG. 2) andare held into the cutouts 172 by pins 182 and 183 (seen in FIG. 2). Theopening and closing of clamp 40 is accomplished in the same manner asdisclosed in previously incorporated Ser. No. 07/780,014, and detailsmay be obtained by reference to the same.

As may be seen with reference to FIG. 3 and 3a, clamp members 20 and 22are mirror images of each other, except that the rear portions 170 ofthe base portions 70 which receive the link members (connectors) 50, 52are identical rather than being mirror images. The change at the rearportion 170 of the base portion permits the link members to extend pasteach other and helps provide the high leverage dual pivot arrangementexplained in detail in previously incorporated Ser. No. 07/780,014.

As seen in FIGS. 3, 3a, and 4, each of the opposed elongate clampmembers has a longitudinally extending substantially straight baseportion 70, 70' which is in-line with the axis 72 of push rod 60, anintegral substantially straight middle portion 73, 73' which extendsaway from the axis 72 of the base portion 70 at an angle of about 5° to20° indicated at 75, and a curved terminal portion 77, 77' which extendsback toward the axis 72 of the base portion 70 at an angle of betweenabout 70° and 90° indicated at 79. The end 84 of curved terminal portion77, and the tangential end 85 of intermediate portion 73 each extendbeyond the longitudinal projection 86 of base portion 70. However, bothof these locations are within the longitudinal envelope of trocar tube80 through which the Jacobs' clamp tool is inserted.

Typical dimensions for a Jacobs' type clamp in accordance with thepresent invention are:

length of base portion: 0.30 inches

length of intermediate portion: 1.00 inches

length of distal portion: 0.40 inches

Angle "72": 5 degrees

Angle "79": 75 degrees

Width of base portion "70": 0.18 inches

Width of intermediate portion "73": 0.13 inches

Width of terminal portion "77": 0.12 inches

The configuration of the Jacobs' type clamp as above-described providesa curved terminal portion which traverses a distance transverse thelongitudinal axis of the tool which is approximately equal to thediameter of the trocar tube through the tool is passed. Thus, for a tenmillimeter trocar tube, the transverse distance is about tenmillimeters. The increased length of the curved terminal portionincreases the usefulness of the clamp in the dissection of ducts andarteries.

There has been described and illustrated herein a laparoscopic Jacobstype clamp. While particular embodiments of the invention have beendescribed, it is not intended that the invention be limited exactlythereto, as it is intended that the invention be as broad in scope asthe art will permit. Thus, while a particular tool arrangement wasdisclosed, it will be appreciated that the Jacobs type clamp endeffectors can be used with different types of instruments. Similarly,while the opening and closing of the clamps was described as beingaccomplished through the use of a high leverage dual pivot arrangement,a single pivot arrangement such as is disclosed in U.S. Ser. No.07/680,392 can be utilized. Further, while preferred lengths, widths,and angles for the end effector clamps were described, it will beappreciated that other dimensions can be utilized, provided, of course,that the middle portion curve away from the longitudinal axis of thetool, and that the distal (terminal) portion curve back at a relativelylarge angle (e.g., approximately 70-90 degrees). In this manner arelatively sharp sweep for the end effectors is provided which extendsalmost the full diameter of the trocar tube. Therefore, it will beapparent to those skilled in the art that other changes andmodifications may be made to the invention as described in thespecification without departing from the spirit and scope of theinvention.

What is claimed is:
 1. In a surgical instrument adapted for insertionthrough a trocar tube and having a hollow tube with distal and proximalends and a first longitudinal axis, a clevis coupled to the distal endof said hollow tube, first and second pivot pins, first and secondelongate opposed clamp members each having a proximal base portionhaving a first through-hole for pivotally engaging said clevis with arespective one of said first and second pivot pins, and an actuationmeans extending through said hollow tube and coupled to said baseportion of said first and second clamp members for effecting pivotalrotation of said clamp members, an improvement in said first and secondclamp members comprising:a) each said clamp member further including anintermediate portion and a distal portion integral with said baseportion, said intermediate portion and said distal portion of saidsecond clamp member being substantially a mirror image of saidintermediate portion and said distal portion of said first clamp member,each said base portion having a second longitudinal axis substantiallyparallel said first longitudinal axis, each said intermediate portionangling away from said second longitudinal axis of said base portion atan angle of between about 5 to 20 degrees, and each said distal portionangling back toward and past said first longitudinal axis at an angle ofbetween about 70 to 90 degrees relative thereto, wherein at least aportion of said intermediate portion extends along a horizontal axisperpendicular to said first longitudinal axis beyond a longitudinalprojection of said base portion in a first direction, and at least aportion of said distal portion extends along said horizontal axis beyondthe longitudinal projection of said base portion in a second directionopposite said first direction.
 2. The improvement according to claim 1,wherein:each said clamp member is an integral curvalinear element. 3.The improvement according to claim 2, wherein:each said clamp membertraverses a distance of approximately 10 millimeters along saidhorizontal axis.
 4. The improvement according to claim 1, wherein:eachsaid clamp member has a clamping surface, and each clamping surface hasgrooves, wherein the grooves of said distal portions are at an angle ofbetween about 0 to 20 degrees relative to said first longitudinal axis,and wherein the grooves of said intermediate portions are at an angle ofbetween 70 to 90 degrees relative to said first longitudinal axis. 5.The improvement according to claim 4, wherein:each said clamp member isan integral curvalinear element, and said base portions and said distalportions each have lengths which are about 0.25 to 0.5 the length ofsaid intermediate portions.
 6. The improvement according to claim 5,wherein:said actuation means in said surgical instrument comprises apush rod extending through said hollow tube and connecting means forconnecting said push rod to said base portions of said first and secondclamp members, said connecting means being coupled to said push rod andto said base portions of said first and second clamp members, and eachsaid base portion includes means for coupling to said connecting means.7. The improvement according to claim 1, wherein:said base portions andsaid distal portions each have lengths which are about 0.25 to 0.5 thelength of said intermediate portions.
 8. The improvement according toclaim 1, wherein:said actuation means in said surgical instrumentcomprises a push rod extending through said hollow tube and connectingmeans for connecting said push rod to said base portions of said firstand second clamp members, said connecting means being coupled to saidpush rod and to said base portions of said first and second clampmembers, and each said base portion includes means for coupling to saidconnecting means.
 9. An endoscopic Jacobs type curved clamp apparatus,comprising:a) a hollow tube having a first end, a second end, and alongitudinal axis; b) a clevis mechanically coupled to said first end ofsaid hollow tube; c) first and second pivot pins; d) first and secondelongate opposed clamp members, each clamp member having a proximal baseportion, an integral intermediate portion, and an integral distalportion, said intermediate portion and distal portion of said secondclamp member being substantially a mirror image of said intermediateportion and distal portion of said first clamp member,each said baseportion having a first through-hole pivotally engaging said clevis witha respective one of said first and second pivot pins, each saidintermediate portion angling away from said longitudinal axis in a firstdirection, and each said distal portion angling back toward and pastsaid longitudinal axis at an angle of between about 70 to 90 degreesrelative thereto, wherein at least a portion of said distal portionextends along a horizontal axis perpendicular to said longitudinal axisbeyond a longitudinal projection of said base portion in a seconddirection; e) a rod extending at least partially through said hollowtube and having a first end and a second end, said rod being coupled tosaid first and second elongate opposed clamp members; and f) actuatingmeans engaged to said second end of said rod for imparting reciprocalmotion to said rod relative to said hollow tube which reciprocal motionis translated into pivotal motion of said pivotally engaged opposedclamp members.
 10. An endoscopic Jacobs type curved clamp apparatusaccording to claim 9, wherein:said intermediate portion extends alongsaid horizontal axis beyond said longitudinal projection of said base ina third direction opposite to said second direction.
 11. An endoscopicJacobs type curved clamp apparatus according to claim 10, wherein:eachsaid clamp member is an integral curvalinear element.
 12. An endoscopicJacobs type curved clamp apparatus according to claim 11, wherein:eachsaid clamp member traverses a distance of approximately 10 millimetersalong said horizontal axis.
 13. An endoscopic Jacobs type curved clampapparatus according to claim 10, wherein:each of said opposed clampmembers has a clamping surface, and each said clamping surface hasgrooves, wherein the grooves of said distal portions are at an angle ofbetween about 0 to 20 degrees relative to said first longitudinal axis,and wherein the grooves of said intermediate portions are at an angle ofbetween 70 to 90 degrees relative to said first longitudinal axis. 14.An endoscopic Jacobs type curved clamp apparatus according to claim 13,wherein:each said clamp member is an integral curvalinear element, andeach said intermediate portion has a first length, and said baseportions and said distal portions each have second and third lengthswhich are each about 0.25 to 0.5 the length of said first length.
 15. Anendoscopic Jacobs type curved clamp apparatus according to claim 10,wherein:each said intermediate portion has a first length, and said baseportions and said distal portions each have second and third lengthswhich are each about 0.25 to 0.5 the length of said first length.